Healthcare News & Insights

Feds charge Texas doc with $375M Medicare fraud

The feds have filed charges alleging a Texas doctor perpetrated the largest health care fraud in U.S. history. According to the prosecutors, Dr. Jacques Roy ran a complicated Medicare fraud scheme that skimmed $375 million since 2006. In fact, the scope of the fraud was so huge, that industry experts say prosecutors should’ve uncovered the problem much earlier.

One expert estimated a legitimate practice would have to be treating a million patients at 30 locations to justify the kind of billings Roy racked up.

Prosecutors say Roy and his office manager paid so-called recruiters $50 a pop to go door-to-door in neighborhoods, asking the residents to sign off on forms stating the doctor had treated them in their homes. The recruiters also signed up residents at local homeless shelters.

The office manager and the owners of five local home health agencies were also charged in relation to the fraud. Additionally, $2.3 million in payments to 78 other home health agencies were suspended.

Federal officials discovered the fraud through the use of new data analysis tools intended to catch unusual billing practices or trends. For an example of what kinds of data could be a red flag, 99% of doctors have certified 104 or fewer patients for home health care. Roy had certified more than 5,000.

If convicted, Roy faces a maximum sentence of 100 years in prison and a minimum of $18.5 in fines.

  • Mario a. Delgado Md

    the government has exactly what it deserves.
    If you are an honest hard working physician then you are not allowed to properly care for your patients. It’s called conflict of interest. If you are a business man or someone who has nothing to do delivering medical care then you will be a legitimate provider.
    Welcome to to the medical industry, hello wallstreet, hello HMO’s. I’m 100% certain that this Texas physician will not collect 2 cents on the dollar but as much as I condemn his act all others involved have no conflict if interest.

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